Advanced Practice Providers and Western Providers Are Associated With Increased Likelihood of Benign Skin Biopsies: A Cross-sectional Analysis.

Background And Objective: To identify provider-related characteristics associated with a higher proportion of benign skin biopsies.

Patients And Materials/methods: Medicare Part B database was analyzed, and for each provider, the number of skin biopsies that he/she performed that were benign lesions was estimated.

Results: Increased benign skin biopsies were performed by nurse practitioners and physician assistants (as compared to Doctor of Medicine/Doctor of Osteopathic Medicine) (odds ratio [OR] of 1.

Wide Local Excision Before Sentinel Lymph Node Biopsy in Melanoma.

Background: Current guidelines suggest that wide local excision of thick melanomas be delayed until sentinel lymph node biopsies can be performed.

Objective: To examine the literature and determine if there is a scientific basis for delaying wide local excision of thick melanomas.

Materials And Methods: A narrative review of the literature was undertaken to examine all available studies on the subject.

5-Year Follow-Up of a Physician Performance Feedback Report Intervention to Reduce Overuse and Excess Cost: A National Cohort Study.

Background: Mohs micrographic surgery efficiently treats skin cancer through staged resection, but surgeons' varying resection rates may lead to higher medical costs.

Objective: To evaluate the cost savings associated with a quality improvement.

Materials And Methods: The authors conducted a retrospective cohort study using 100% Medicare fee-for-service claims data to identify the change of mean stages per case for head/neck (HN) and trunk/extremity (TE) lesions before and after the quality improvement intervention from 2016 to 2021.

Starting a Solo Practice.

Opening a small private dermatology practice can be a rewarding experience. It may seem like a lot of trouble, but in no other setting will you have so much freedom, control, and directly be able to see the consequences of your efforts. Economically, you must realize that in other settings, all these "chores" you must do in a solo practice are paid for by you out of overhead, which can greatly exceed what it costs if you do it yourself in a small practice.

Skin biopsy and skin cancer treatment use in the Medicare population, 1993 to 2016.

Background: Skin biopsies are increasing at a rapid rate, and some may be unnecessary. Although skin cancer incidence is rising, there is varied biopsy accuracy between dermatologists and advanced practice professionals (APPs). A comparison of Current Procedural Terminology code (American Medical Association, Chicago, IL) use for skin biopsy and skin cancer treatment over 18 years and a comparison of provider types is needed.

Evaluation of a Peer-to-Peer Data Transparency Intervention for Mohs Micrographic Surgery Overuse.

Importance: Mohs micrographic surgery (MMS) is a skin cancer treatment that uses staged excisions based on margin status. Wide surgeon-level variation exists in the mean number of staged resections used to treat a tumor, resulting in a cost disparity and question of appropriateness.

Objective: To evaluate the effectiveness of a behavioral intervention aimed at reducing extreme overuse in MMS, as defined by the specialty society, by confidentially sharing stages-per-case performance data with individual surgeons benchmarked to their peers nationally.

Analysis of dermatologic procedures billed independently by nonphysician practitioners in the United States.

Background: Nonphysician practitioners (NPPS), including nurse practitioners (NPs) and physician assistants (PAs) are expanding their scope of practice outside of primary care and performing more procedures in dermatology.

Objective: To understand the scope and geographic pattern of practice by NPs and PAs in dermatology in the United States.

Methods: Cross-sectional retrospective cohort analysis of dermatology practices in the 2014 Medicare Physician/Supplier Procedure Summary master file, which reflects Part B carrier and durable medical equipment fee-for-service claims in the United States.

Understanding Mohs Micrographic Surgery: A Review and Practical Guide for the Nondermatologist.

The incidence and diagnosis of cutaneous malignancies are steadily rising. In addition, with the aging population and increasing use of organ transplant and immunosuppressive medications, subsets of patients are now more susceptible to skin cancer. Mohs micrographic surgery (MMS) has become the standard of care for the treatment of high-risk nonmelanoma skin cancers and is increasingly used to treat melanoma.

Use of Skin Biopsies Among Dermatologists.

Background: Skin biopsies are essential to establish a diagnosis in many skin diseases. Utilization has been increasing rapidly and represents a significant health care cost. There are no benchmarks or baselines to guide the practice of skin biopsies.

Outlier Practice Patterns in Mohs Micrographic Surgery: Defining the Problem and a Proposed Solution.

Importance: Outlier physician practices in health care can represent a significant burden to patients and the health system.

Objective: To study outlier physician practices in Mohs micrographic surgery (MMS) and the associated factors.

Design, Setting, And Participants: This retrospective analysis of publicly available Medicare Part B claims data from January 2012 to December 2014 includes all physicians who received Medicare payments for MMS from any practice performing MMS on the head and neck, genitalia, hands, and feet region of Medicare Part B patients.

Mohs Micrographic Surgery for the Treatment of Merkel Cell Carcinoma.

Background: Merkel cell carcinoma (MCC) is a rare, aggressive malignant neoplasm. Traditionally, wide local excision has been used for local control. However, the tissue-sparing capability of Mohs micrographic surgery (MMS) and the greater certainty of complete tumor removal offer a potential advantage over wide local excision if MMS offers acceptable cure rates.

Incidence Estimate of Nonmelanoma Skin Cancer (Keratinocyte Carcinomas) in the U.S. Population, 2012.

Importance: Understanding skin cancer incidence is critical for planning prevention and treatment strategies and allocating medical resources. However, owing to lack of national reporting and previously nonspecific diagnosis classification, accurate measurement of the US incidence of nonmelanoma skin cancer (NMSC) has been difficult.

Objective: To estimate the incidence of NMSC (keratinocyte carcinomas) in the US population in 2012 and the incidence of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in the 2012 Medicare fee-for-service population.

Scope of physician procedures independently billed by mid-level providers in the office setting.

Importance: Mid-level providers (nurse practitioners and physician assistants) were originally envisioned to provide primary care services in underserved areas. This study details the current scope of independent procedural billing to Medicare of difficult, invasive, and surgical procedures by medical mid-level providers.

Objective: To understand the scope of independent billing to Medicare for procedures performed by mid-level providers in an outpatient office setting for a calendar year.